TWI653997B - Laryngeal mask - Google Patents

Abstract

A device for breathing support for humans or animals, this device combines a standard laryngeal mask for use with mechanical ventilation, and has a laryngeal mask device for continuous positive pressure application in the airway, in a continuous manner at Slightly pressurized air or oxygen is provided throughout the breathing cycle of the larynx for use in those pathologies that require two methods of breathing support or in those diagnostic or therapeutic actions.

Description

Laryngeal mask

The invention relates to the field of ventilation of the human or animal body.

The mode of breathing support with continuous positive oxygen pressure makes it possible to increase the patient's alveolar ventilation by establishing a positive oxygen pressure in the airway of the patient. This positive oxygen pressure can be constant or non-constant, and will be The patient will have the minimum pressure obtained in his airway catheter by this mechanism during his fully exhaled phase.

So far, this continuous positive oxygen pressure has been established at the entrance and exit of the patient's airway, that is, in the mouth or nose, without the need for artificial access to the internal airway, as has occurred in the case of tracheal intubation. Different. Conventionally, during the ventilation, a continuous positive oxygen mask or nasal tube type device is used, which applies some pressure on the skin of the patient's face to try to avoid oxygen leakage, and all the continuous positive oxygen pressure attempts all Reach the patient's airway, but with the big problem that the continuous positive pressure oxygen application also turns to the patient's stomach, causing the risk of swelling, pain, and vomiting of the gastric secretion, which can turn to the lung and improve High risk of killing the patient Of aspiration pneumonia. For this reason, since the continuous positive pressure has hitherto been non-invasively applied to the inside of the airway, it has come to be referred to as non-invasive mechanical ventilation.

There are several devices on the market that establish this continuous positive oxygen pressure at the inlet and outlet to the airway, such as the mouth or nose. This technique includes continuous positive air or oxygen pressure (measured in cm of water) applied above atmospheric pressure, which increases the lung's capacity and increases oxygenation, which helps the patient to breathe spontaneously, and always With continuous positive pressure, even in the breathing phase of full exhalation. Among other things, this technique is widely used in patients with obstructive sleep apnea.

The application of continuous positive pressure to the airway non-invasively dates back to 1930, when Alvan Barach demonstrated that continuous positive pressure of oxygen in the airway was useful in the treatment of acute pulmonary edema, but it was named in 1971 and Gregory, who originally described it, applied it to respiratory distress in newborn infants. Soon after, as early as 1972, Civetta and Falke described their advantages in adults with acute respiratory failure.

Compared with tracheal intubation, continuous positive oxygen pressure presents the advantage of a lower risk of complications, among other things, allowing the patient to be awake and coughing and maintaining the airway response ability and eliminating secretions, improving the quality of sleep and promoting the patient The fact that its breathing muscles are used to avoid muscle atrophy.

It should also be noted that for other more serious diseases, it is also necessary to make the patient fall asleep and resort to tracheal intubation, such as in the treatment combined with anesthesia, such as for intubation with an endotracheal tube. Patients to allow oxygenation, or use artificial ventilation with a laryngeal mask device Sleeping patient.

However, there are cases similar to those in the present invention, in which it would be desirable to have a standard laryngeal mask that can be used independently as a standard mechanical ventilation, and also to be used continuously in patients with spontaneous breathing Device for laryngeal mask for positive oxygen pressure. This device would be advantageous, for example, in cases where the patient's lung pathology is more severe and requires positive pressure oxygen to have a greater effect than a mask or prong, or where diagnostic or therapeutic tests are required through the airway. In patients, where the oxygen supply is reduced due to this (as in the case when using probes, fiberscopes, etc.), and where oxygen needs to be supplied to the patient at the same time, continuous positive oxygen pressure is not implemented to the stomach High risk (can cause stomach swelling, dilation, pain, and vomiting of dangerous aspiration bronchopneumonia).

The device according to the present invention responds to this need by providing a device that combines the performance of a standard laryngeal mask device with a laryngeal mask for implementing continuous positive oxygen pressure. This type of device helps to solve the aforementioned problems and thus achieve the desired purpose.

The solution to this problem is based on the fact that the inventors have found that this device can be made based on a standard laryngeal mask provided with at least two tubes, where both of these tubes can be used to allow oxygen or gas to enter the The patient's internal airways and / or exit from the patient's internal airways. Both tubes can have the same or different diameters. When the device is intended to act as a standard laryngeal mask, only one of these tubes remains open for the entry and exit of the oxygen or gas, and the The other tube remains closed. In these cases, the device acts as a standard laryngeal mask in the traditional ventilation mode, and through the open tube, oxygen or gas is forced into and out of the patient's airway alternately, so the inhaled and exhaled gas is expelled into And expel the patient's airway. On the other hand, when the device is intended to operate in continuous positive oxygen pressure mode, the two tubes are selectively kept open to a variable range. In these cases, a continuous flow of air or oxygen is applied to one of the tubes by an external oxygen supply system, whereas the exhaled air or gas is allowed to exit through the other tube. Through the appropriate variable adjustment of the flow of air or oxygen applied to one tube, and the variable opening of the other tube, the appropriate adjustment of the amount of oxygen introduced into the patient's airway and the exhaled gas is achieved. These conditions establish and maintain residual values of positive oxygen pressure in the arches of our laryngeal masks and in the airways of the patient. By varying or changing the inner flow supply and by changing the variable diameter of the two tubes, we can achieve a higher or lower residual positive pressure than can be achieved.

Therefore, in one aspect, the present invention is directed to a throat cover having the following components: an arch chamber (2) having a cavity (2a), the arch chamber (2) being attached to a throat ring (3 ) For sealing the internal airway of the patient; at least one oxygen tube (4) connected to the chamber (2a) of the arch chamber (2) for allowing oxygen or gas to enter or leave the internal airway of the patient; And at least one laryngeal discharge tube (5), which is different from the oxygen tube (4) and is also connected to the chamber (2a) of the arch chamber (2) for allowing air and / or secretions to leave the patient Internal airway.

Even if all such tubes can be varied or changed independently of one another in diameter, and do not need to have the same or different diameters, in a preferred embodiment, the diameter of the throat discharge tube (5) is greater than the diameter of the oxygen tube (4) The diameter is small. In a more preferred embodiment, the diameter of the throat discharge pipe (5) is between 20 and 70% of the diameter of the oxygen pipe (4); in an even more preferred embodiment, the throat discharge pipe (5) ) The diameter is between 40 and 65% of the diameter of the oxygen tube (4), and in a more preferred embodiment, the diameter of the throat discharge tube (5) is the diameter of the oxygen tube (5) About 60%. In a very convenient embodiment, the inner diameter of the throat discharge pipe (5) is 5 mm, and the inner diameter of the oxygen pipe (4) is 8.5 mm. In this way, through the use of a standard oxygen supply like a venturi flow system, with an oxygen flow rate of about 10 liters / minute, we can easily achieve or establish a residual oxygen positive of about 5 cm of water in the patient's internal airway. Pressure, which is the optimum value for operation under conditions of continuous positive oxygen pressure. However, the same or different oxygen flow rates can be achieved by other organizations as well, such as by appropriate adjustment of the oxygen flow rate in the oxygen supply device, and in different combinations with the same or different diameter oxygen and throat exhaust pipes .

Also in a preferred embodiment, the laryngeal mask may additionally include any of the following additional tubes in any combination: a gastric drainage tube (6), an oxygen tube (4), and the throat drainage tube ( 5) Instead, it will not connect to the chamber of the arch chamber, but it will connect directly to the throat orifice (3a) in the distal part of the throat loop (3), usually through the arch The chamber of the pack or below the chamber of the arch to extract the accumulation in the patient's stomach by the application of continuous positive oxygen pressure Excess air or oxygen in the air, and extracting accumulated secretions that can cause flatulence and vomiting and aspiration pneumonia therein; and a tube (7), which is also connected to the cavity of the arch chamber (2) The chamber (2a) is connected to a pressure measuring device for measuring the pressure existing inside the arch chamber of our throat cover.

In an advantageous embodiment, the device according to the present invention is provided with the oxygen pipe (4) and the throat discharge pipe (5), plus two other aforementioned additional pipes. However, the present invention is not necessarily limited to the existence of the four pipes, and it may have any combination of at least the oxygen pipe (4) and the throat discharge pipe (5) plus any other pipe, depending on the implementation of the The needs of the operating patient and / or doctor.

In another preferred embodiment, the tubes or piping present in the device are joined by an additional element that surrounds them and keeps them joined. This element may be extra rigid and also prevent the The patient's function of collapsing these tubes makes them collapse and close.

Each of these tubes can be provided with a separate cap or plug that allows the tubes to be closed or opened in varying degrees, which allows our throat masks to be used in any of the two ventilation modes One (as a standard laryngeal mask or as a continuous oxygen positive pressure laryngeal mask), and by closing or opening or inserting or removing the caps on these tubes, or by joining them to other devices. For this purpose, the covers or plugs may have variable openings. A cap with a variable opening for the laryngeal discharge tube (5) is particularly useful because, in this way, the positive oxygen pressure maintains a residual value inside the laryngeal mask arch chamber, or the patient's internal airway Can be easily adjusted without adjustment The oxygen flow rate from the oxygen supply device. By the way, this can also be adjusted to increase or decrease the positive oxygen pressure maintained at the residual value inside the laryngeal mask arch chamber or inside the patient's internal airway.

1‧‧‧ device

2‧‧‧ arch room

2a‧‧‧chamber

3‧‧‧throat ring

3a‧‧‧ throat orifice

4‧‧‧ oxygen tube

5‧‧‧throat discharge tube

6‧‧‧ Stomach drainage tube

7‧‧‧ tube

8‧‧‧ components

9‧‧‧ elbow

9a‧‧‧ opening

9b‧‧‧ opening

9c‧‧‧ opening

Figure 1 shows a side view of the device (1), including an arch chamber (2), a throat ring (3), and a tube (4) present in an embodiment of the invention.

Figure 2 shows a front view of the throat ring (3) and the tube present in this embodiment of the invention. In this case, the tube system is all those mentioned above, that is, for allowing oxygen or gas to enter or leave the Oxygen tube (4) of the patient's internal airway; larynx drainage tube (5) for allowing air and / or secretions to leave the patient's internal airway; the gastric drainage tube (6), and the pressure measuring tube ( 7).

Figure 3 shows an embodiment comprising an additional element (8) surrounding the tubes and keeping them joined together, this element additionally having the function of preventing the patient from biting the tubes and causing them to collapse.

Figure 4 shows a perspective view of the throat ring and tube mentioned above in an embodiment of the invention.

Figure 5 shows an embodiment comprising an elbow (9) with three openings, one opening (9a) for the continuous gas or oxygen flow supply and the other opening (9b) for fiber optic mirrors, bogies , The introduction of suction catheters or additional accessories for the echocardiograph, and another opening (9c) for connecting the oxygen tube (4) to our laryngeal mask.

As such, the hood can be used in a two-ventilation mode. In either mode, the arch chamber and the laryngeal ring are first introduced into the patient's throat. Once introduced, the laryngeal ring is expanded if necessary to seal the patient's throat. Then, either of the following two modes of operation is applied, depending on the ventilation mode selected by the doctor or practitioner: in the standard or traditional ventilation mode, where the device is used as a traditional laryngeal mask, The oxygen tube (4) will be opened and connected to an external oxygen supply device, such as a respirator or a ventilation bag. When in operation, the air or oxygen is forced into the patient's internal airway through this tube, and the breathed air is also expelled from the patient's internal airway, thus causing a standard laryngeal mask to be used in a standard or traditional way. Function for working in ventilation mode. The throat discharge tube (5) will be inserted or closed to avoid interference with the oxygen tube (4). The gastric discharge tube (6) is preferably to be opened to facilitate aspiration of the stomach contents and is inserted into the inhalation device, and the pressure measurement tube (7) is preferably to be inserted into the pressure measurement device .

In a ventilation mode that supplies continuous positive oxygen pressure to the patient: In this ventilation mode, the oxygen tube (4) will be opened and connected to the external air and oxygen supply so that a continuous or variable flow supply can be supplied Implementation into the patient's internal airway and the laryngeal discharge tube (5) tube will be opened to a variable degree to allow the exhaled air to exit on the outside of the airway. The gastric drainage tube (6) is preferably to be opened to allow the gas or gastric contents of the patient's stomach to exit and to be inserted into an inhalation device, and the pressure measuring tube (7) is preferably Will be connected to a pressure measuring instrument. In an example In this case, the oxygen supply may be a continuous or variable flow of air or oxygen through a tap of a venturi device. In this way, continuous positive pressure is maintained in the patient's internal airway. In this ventilation mode, we can use a selective elbow (9) with three openings, one opening (9a) for the continuous gas or oxygen flow supply and the other opening (9b) for the fiber like The introduction of endoscopes, bogies, suction catheters or additional accessories for cardiac ultrasound meters, and another opening (9c) for the oxygen tube (4) connected to our laryngeal mask. In this way, those additional accessories can be smoothly operated in accordance with their individual purposes, while the supply of oxygen is continuously provided to the patient's internal airway.

The mask of the invention can be advantageously used, for example:

-In patients with trauma, injuries, and facial burns, where the mask or fork tube system used to apply continuous positive pressure to the patient's face is not suitable;

-In patients with beard or lip beard, without teeth, giant tongue, anatomical abnormalities, goiter, and others, it is used in masks or prongs that are placed on the patient's face by continuous positive pressure Not suitable because the hood does not seal properly and there is a leak of oxygen on the face.

-In patients who are at risk, the danger is that the continuous positive pressure of oxygen supplied by the mask will swell the patient's stomach, causing the risk of gastric dilation, swelling, pain, and vomiting, which will increase bronchial breathing and have a high death rate Rate of pneumonia.

When the positive pressure mask does not manage to restore the patient's normal level of oxygen saturation and the need for non-intubation, and when the patient cannot tolerate the positive pressure They are also useful when pressing on a mask, and when they do not want to intubate the patient with sedative and relaxing drugs.

The mask of the invention also facilitates bronchiectomy and reduces the resistance of the airway, re-expands the atelectasis, and allows the inspiratory muscles to rest.

And when we want to maintain the residual positive oxygen pressure on the arch of the laryngeal mask and on the airway of the patient, when we want the patient to fall asleep with spontaneous breathing and maintain the airway's ability to respond, It's useful.

Claims (14)

A laryngeal mask for ventilation of a human or an animal, the laryngeal mask comprising: an arch chamber having a cavity, the arch chamber being attached to a throat ring to seal the internal airway of the human or animal ; At least one oxygen pipe connected to the chamber of the arch chamber for allowing oxygen or gas to enter or leave the internal airway of the human or animal; and at least one throat exhaust pipe, which is different from the oxygen pipe, and also A chamber connected to the arch chamber for allowing oxygen or gas entering the human or animal's internal airway through the oxygen tube to leave the human or animal's internal airway, wherein when the laryngeal mask is in a standard ventilation mode In use, the oxygen tube allows oxygen or gas to enter and leave the internal airway of the human or animal, and the laryngeal exhaust tube is constructed to be closed, and wherein when the laryngeal mask is used in a continuous positive pressure airway mode, The oxygen pipe allows oxygen or gas to enter the human or animal's internal airway, and the throat discharge pipe allows oxygen or gas to leave the human or animal's internal airway. For example, the throat cover of item 1 of the patent application range, wherein the diameter of the throat discharge pipe is between 20 and 70% of the diameter of the oxygen pipe. For example, the throat cover of item 1 or 2 of the patent application scope, wherein the diameter of the throat discharge pipe is between 40 and 65% of the diameter of the oxygen pipe. For example, the throat cover of item 1 or 2 of the patent application scope, wherein the diameter of the throat discharge pipe is about 60% of the diameter of the oxygen pipe. For example, the throat cover of item 1 of the patent application scope, wherein the diameter of the throat discharge pipe is the same as the diameter of the oxygen pipe. For example, the laryngeal mask of the scope of patent application No. 1 or 2 further includes a gastric drainage tube connected to the throat tube orifice located at the distal part of the throat ring, for extracting the human or animal Excessive air and / or secretions accumulated in the stomach. For example, the laryngeal mask in the scope of patent application No. 1 or 2, which additionally contains an additional tube connected to the chamber of the arch chamber, and connected to a pressure measuring device at the opposite end to measure the presence The pressure inside the arch. For example, the laryngeal mask of item 1 or 2 of the patent application scope further includes a protection element surrounding at least one of the oxygen tube, the laryngeal discharge tube, the gastric discharge tube and the additional tube to protect them from collapse. Shrink or bite and keep them together. For example, the laryngeal mask of the scope of patent application No. 1 or 2, wherein the laryngeal loop is expandable. For example, the laryngeal mask of item 1 or 2 of the patent application scope, wherein the laryngeal loop is non-swellable. For example, the laryngeal mask in the scope of patent application No. 1 or 2 further includes at least one cover or plug for gradually or completely opening or closing the oxygen tube, the throat discharge tube, the gastric discharge tube and the extra tube. At least one of. For example, the laryngeal mask of the scope of patent application No. 11, wherein the cap or plug is a variable orifice plug, and is designed to be suitable for closing the laryngeal discharge tube. For example, the laryngeal mask of item 1 or 2 of the patent application also includes an elbow with three openings. One of the three openings is used for oxygen supply, and the other opening is to allow the introduction of additional accessories. And another opening will be connected to the oxygen tube. For example, the laryngeal mask according to item 13 of the patent application, wherein the additional accessory is selected from the group consisting of a fiber endoscope, a suction catheter, an echocardiograph and a bogie.